Presented by Tina Palmer and Shelly Parker Betty Neuman’s System’s Model Presented by Tina Palmer and Shelly Parker Betty M. Neuman, RN, BSN, M.S., Ph.D, FAAN

Neuman’s Systems Model Nursing is more than caring for an illness, but is about viewing the patient as a whole (holistic care) and assessing every aspect of an individual that affects health including emotional and spiritual well being.

History of Neuman Born in 1924 in Lowell, Ohio In 1947 she obtained her Registration Nurse Diploma from the People’s Hospital School of Nursing in Akron Ohio In 1957 she obtained a double major in psychology and public health at the University of California at Los Angeles (UCLA) In 1966 she completed a Master’s degree in mental health and Public Health Consultation at UCLA.

History of Neuman In 1967, along with a co-worker she developed the first community mental health program for graduate students in the Los Angeles area She worked in a variety of nursing roles which also included teaching. An interesting fact is that she also assisted her husband to open and maintain a medical practice. In 1970, she began to develop the conceptual systems model as a way to teach introductory nursing. This was published in 1972 after evaluation of the model. The first publication was titled, “A model for teaching total person approach to patient problems.” She continued to refine her publications and made further changes in the model. The last update was made in 2010. In 1985 she obtained her doctorate in Clinical Psychology from Pacific Western University

History of Neuman In 1988, she founded the Neuman Systems Model Trustee group to maintain the integrity of the Neuman Model System. In 1992 she was given an Honorary Doctorate of Letters at the Neumann College in Ashton Pennsylvania In 1993 she was named Honorary Member Fellowship of the American Academy of Nursing (FAAN) In 1998 she was given an Honorary Doctorate of Science from the Grand Valley State University of Michigan.

Currently Independent Curriculum Consultant in Nursing Private Practice Health Consultant Author Lecturer Instructor Individual and Family Counselor Founder and Member of the Neuman Systems Trustee Group, Inc

Influences She developed the Systems Model based on the influences of: 1. Gestalt theory: idea that life has ups and downs but if a person is able to cope with the situation, balance occurs and illness can be prevented. 2. Seyle’s theory: stressors create tension in the body which can be either positive or negative. 3. deChardin and Cornu: life as a whole 4. Von Bertalanfy, and Lazlo on general system theory. 5. Lararus: on stress and coping

What is the Neuman Systems Model? The model views the person as a layered, multidimensional whole that is in constant dynamic interaction with the environment. Open system with a core of energy that interacts with the environment The goal is to achieve optimal system stability and balance and illness has varying degrees of stability The systems model really looks at the person as having many layers that has constant interaction with the environment that causes changes in the system. The model starts with the concept of a core that has an open system that interacts with the environment with the goal of working through different stages of stability

What is the Neuman Systems Model? Involves not only providing care to the patient, but also to the family/caregivers and the relationships established

Key Concepts Central Core System variables Genetic features Strengths and weaknesses of the system The system constantly changes and evolves and the goal is to obtain balance Lines of resistance is a protective mechanism that attempts to bring the body to its usual state

Key Concepts Each layer is made up of five person variables Physiological Psychological Sociocultural Spiritual Developmental

Key Concepts Protective mechanisms that maintain a patients stability: Flexible lines of defense: is referred to as “accordion like” and flexible for example, and expands or contracts as a response to fight off stressors. Examples include change in eating or sleeping patterns Normal lines of defense: represents the normal state of adaptation over time Lines of resistance: help protect, for example, leukocytosis response to invading microorganisms

Key Concepts Reconstitution Refers to the is the change in energy as a result of a reaction to stressors and begins at any point during invasion of a stressor This can cause a fluctuation from the normal line of defense and refers to the ability of the body to adapt

Key Concepts Stressors May have a positive or negative reaction and have an impact on the stability of the system and can be internal or external; Intrapersonal-within the person Interpersonal-between individuals Extrapersonal-outside the individual

Key Concepts Prevention This is the primary nursing intervention which focuses on keeping stressors and stress from creating a detrimental outcome

Key Concepts Primary: occurs before the system reacts to a stressor. Prevention includes health promotion and wellness. Nursing interventions include identification and reduction of risk Examples of nursing interventions at this state may include: providing education and support for smoking cessation, relaxation techniques, anger or stress management

Key concepts Secondary: occurs after the system reacts to the stressor. Nursing interventions include focus on preventing damage to the system. Examples of nursing interventions may include medications for treatment or encouragement to verbalize feelings and emotions

Key Concepts Tertiary: occurs after the system has been treated through secondary. Nursing interventions include providing support to increase energy or conserve energy to promote reconstitution of the body back to normal state Examples of nursing interventions may include re-assessing the patients ability to complete tasks or routine consults for counseling

Key Concepts Nursing care under this model not only focuses on the patient, but also focuses on the family/caregiver/community (holistic care) Nursing care under this model includes achieving goals that reduce stressors factors for patients at any given point in their state of health

3 Stage Nursing Process Diagnosis Goals Outcomes

Using the model in nursing practice Holistic assessment obtained from patient and family/caregiver including patient profile, stressors, history and physical, lifestyle patterns, health concerns, past experiences, spiritual, psychosocial and education needs. Develop and implement nursing diagnosis based on the stressors and other needs determined during the assessment process

Using he model in nursing practice Set the goals for the patient that address all aspects of well being Help reduce stressors and provide education to prevent illness Encourage the patient to regain control over their well being Review and evaluate the patients progress

Use of model in nursing practice The Systems Model has been accepted in academic schools and is used in curriculums to teach new student nurses to care for patients This model can be used in all aspects of nursing Initially this was used in Community Mental Health

Case Study A 48 year old Caucasian male, married with a 3 month old and a 6 year old child. He is a Nursing Home Administrator and is known to his colleagues as a hard working and dedicated. His wife is a stay at home mom. He smokes and drinks on occasion when he becomes stressed.

Case Study He arrives at work daily around 7:00 am and immediately rounds the facility to check on Residents and staff. He often drops in the cafeteria when staff are eating and grabs his usual salad Recently his staff notice he has been arriving later after 8:00 am and does not immediately round the facility, rather stays in his office and there are days he does not round. Staff begin to complain to leadership that he is not following up on concerns or paying attention to issues in the facility. His wife also notices changes in that he is sleeping in later and rushes to get to work and now skips breakfast with his family.

Case Study His wife notices he comes home later at night and has difficulty falling asleep. She is also concerned because she has noticed bills coming through the mail that have not been paid. His wife calls their physician to express her concerns because her husband seems withdrawn and no longer spends time with the family.

Case Study He is eventually admitted to the hospital with chest pain and shortness of breath and is diagnosed with pneumonia. Question 1: What level of prevention would the nurse apply to develop interventions to bring the patient to a level of stability? A. Primary prevention B. Secondary prevention C. Tertiary prevention

Case Study Question 2 What type of nursing interventions would you apply during the tertiary phase?

References Nursing Theories, (2012, January 28). Application of Betty Neuman’s system model. Retrieved from http://currentnursing.com/nursing_theory/applic ation_Betty_Neuman’s_model.html Nursing Theory, (2011). Neuman’s systems model. Retrieved from http://nursing- theory.org/theories-and-models/neuman- systems-model.php

References Heyman, P., & Wolfe, S. (2000, April). Neuman systems model. Retrieved from http://www.patheyman.com/essays/neuman/ind ex.htm The Neuman Systems Model Trustee Group, Inc. (2001- 2003). Neuman systems model. Retrieved from http://neumansystemsmodel.org/NSMdocs/neu man_systems_model_trustees.htm